Question: Hello. I was diagnosed Bipolar 10 years ago. Have had many ups and downs.
Now I am taking 600 mgs / Lithium Carb.(AM) and 20 mgs Fluoxetine (PM).

I am very, very depressed. With all the usual symptoms. I live and work in Saudi Arabia currently (rural) without access to a decent psychiatrist. I am desperately trying to get out of this depression. Should I adjust the aforementioned meds?

Thank you.

Thank you for your reply doctor,

Yes, I have had some irregularities with meds.

The timeline (up to now) is this:

1.5 years ago --- (Lithium + Fluox) for one year.
8 months ago --- (Lithium only) for 6 months.
7 weeks ago--- (Lithium + Fluox) up to now.

This depression cycle started about 8 weeks ago. That is why I re-started the Fluox, hoping it would help. But, in the last 3-4 weeks the depression has continued going lower and lower. Now, it is at a dangerous level.

I had many ups and downs over the years because of trying to adjust to medication, being reckless and alcohol and marijuana abuse problems. I can say that alcohol / illicit drugs are NOT a factor now.

I'm eating ok....pretty healthy.

My biggest problems are rumination, worry and anxiety.

It's strongest in the morning and tapers off at night.

It's starting to affect my sleep patterns.

Please doctor, understand. I am alone in this. This is my fight and I have experience, so I know I can win.

I just need some practical advice about the meds I have with me.
Finding a psychiatrist in this region of Saudi Arabia is not possible.

Please inform me if I should change 600mg Lithium / 20mg Fluox to something higher or lower(?)

Please doctor, in your educated opinion. This is the only medicine I have to work with right now. In Saudi, doctor's visits are not confidential and I'd lose my position for seeking out a psychiatrist. I understand that, that might mean I can't stay here. But, I want to try to fix this first.

Thank you.